This study is prompted by the functional reorganizations and mergers between the local health department and the public hospital which have occurred in recent years in several large urban areas, ostensibly as a response to needs of the poor for more and better primary medical care. The goals of the study are to provide a base of useful, and indeed necessary, information and pertinent analyses for use as guidelines for Federal and local government policy, management and planning decisions with respect to the provision by government of ambulatory and primary care for the urban poor. The importance of this study stems from: a) the large number of urban poor affected by these reorganizations; b) the seriousness with which urban governments have viewed the problems associated with the provision of ambulatory (especially primary) care to the poor; and c) the magnitude of effort and resources that have been, and will continue to be, expended in dealing with this problem. The specific objectives to accomplish the study's goals include the following: a) to "map" the nature and extent of the current relationships between public hospitals and health departments; b) to identify the impetus for the the changes in these relationships which the recent reorganizations signify; c) to examine the outcomes of these reorganizations and mergers with particular reference to their impact on the delivery of primary ambulatory care; and d) to compare the outcome of these changes with the situation in urban areas where no reorganizations have occurred. The study will comprise a mail questionnaire and bibliographic research, followed by on-site personal interviews, and analysis of agency reports, evaluative and feasibility studies, planning and budget justification documents, local newspaper accounts, and other pertinent documents. Analysis of the questionnaire will attempt to correlate various demographic, social, political, economic, and health care system variables with the type of hospital/health department relationship. The impact on primary care in areas with reorganizations will be assessed using organizational parameters and compared to "control" areas with traditional hospital/health department relationships. The intended outcome of the study is an assessment of the implications of different forms of mergers and reorganizations for Federal and local decision makers.